Comparison of Adrenal Suppression between Etomidate and Dexmedetomidine in Children with Congenital Heart Disease

Abstract

BackgroundThe aim of this study was to compare plasma cortisol concentration during anesthesia of children with congenital heart disease who received dexmedetomidine (DEX) with those who received etomidate (ETO).Material/MethodsWe recruited 99 ASA physical status II–III pediatric patients scheduled for congenital heart disease (CHD) corrective surgery and divided into them into 3 groups. Group DEX received an infusion of DEX intravenously with a bolus dose of 0.5 μg·kg−1 within 10 min during anesthesia induction, followed by a maintenance dose of DEX 0.5 μg·kg−1·h−1. Group ETO received ETO intravenously with a bolus dose of 0.3 mg·kg−1 without a maintenance dose. Group CON received routine anesthetics as controls. The preset timepoints were: before anesthesia induction (T0), at the end of induction (T1), 30 min after anesthesia induction (T2), at the time of aortic and inferior vena catheterization (T3), and at 180 min (T4) and 24 h (T5) after anesthesia induction.ResultsThe cortisol concentration decreased gradually after anesthesia induction in all groups, and returned to baseline values after 24 h. The cortisol concentration was significantly lower in Group ETO children than in Group DEX or group CON at T4.ConclusionsThe plasma concentrations of cortisol decreased in CHD children after the operation, but returned to baseline after 24 h of anesthesia induction. The adrenal cortex function inhibition induced by ETO in CHD children is longer and more serious than that induced by DEX (if any) during the preoperative period.

Increased Cortisol and Cortisone Levels in Overweight Children

“…In this paper, simultaneous measurement of cortisol and cortisone using an HPLC-MS/MS approach was conducted, and the analyte concentration was lower than that reported by Kjölhede et al [ 8 ] using commercial enzyme immunoassay (EIA), which agrees with a report comparing radioimmunoassay (RIA) and LC-MS/MS methods for salivary cortisol and cortisone measurement [ 30 ]. Therefore, an additional factor to be considered when comparing results from different studies is the use of a multitude of analytical methods, for example RIA [ 9 , 25 ], DELFIA [ 36 ], EIA [ 8 ], ELISA [ 37 – 39 ], chemical immune luminescence assay [ 40 ], and LC-MS/MS [ 9 , 22 , 41 ]. We used HPLC-MS/MS method for simultaneous measurement of these biomarkers, which would be a valuable tool for children due to difficulty in taking blood samples.…”

Etomidate-induced hypokalemia in electronic cigarette users: two case reports and literature review

“…Regarding the timing of the effects of etomidate, a single dose of etomidate given before surgery usually results in a return to baseline levels of the inhibited enzymes by 24 hours after anesthesia induction, while continuous use leads to an inhibitory effect lasting longer than 24 hours, with possibly dose-dependency ( 15 ). Compared with propofol and dexmedetomidine, etomidate has a stronger adrenal suppression effect, and adrenal insufficiency can persist for a long time after discontinuation of continuous etomidate administration ( 16 ).…”

Etomidate and its Analogs: A Review of Pharmacokinetics and Pharmacodynamics

“…In children, etomidate is generally safe as an induction agent [ 20 ]. Similar to the adult population, a single induction dose of etomidate also suppresses the adrenal axis in children [ 131 , 132 ] and etomidate is not suitable for prolonged infusion. Etomidate in children is mainly used in the emergency department [ 133 – 135 ] and in children with congenital heart disease [ 57 , 58 , 136 , 137 ].…”